Balloon Dilation In Patients Research Articles

COMPARISON OF DIRECT STENTING VERSUS PRE-DILATION OUTCOMES IN PRIMARY PCI AT A MAJOR HOSPITAL

Stents are utilized in over 95% of percutaneous coronary interventions (PCIs), and advancements in balloon and stent technologies have fostered the development of direct stent (DS) delivery. This approach, which bypasses pre-dilatation, may offer distinct advantages over conventional stenting (CS), which includes balloon dilation before stenting. Objective: To evaluate the angiographic and short-term clinical outcomes of direct stent placement compared to traditional stenting following balloon dilation in patients undergoing primary percutaneous coronary interventions. Methods: This cross-sectional study was conducted from December 2023 to May 2024 at Hayatabad Medical Complex, Pakistan. One hundred patients undergoing primary PCI were randomly assigned to two groups: Group A (n=50) received direct stent placement, and Group B (n=50) underwent stenting following balloon dilation. Data collection included demographic details, coronary intervention details, and procedural outcomes from medical records. Statistical analyses were performed using SPSS software, with Independent samples t-tests used to compare fluoroscopy times, procedure durations, and contrast usage, considering a P-value < 0.05 as significant. Results: The study enrolled 100 patients, with a mean age of 52.8 ± 11.0 years; 76% were male. The most commonly treated vessel was the left anterior descending artery. Group A demonstrated a significantly shorter fluoroscopy time (4.6 ± 2.9 minutes vs. 6.9 ± 4.1 minutes, P=0.001) and total procedure duration (24.4 ± 12.4 minutes vs. 34.6 ± 13.5 minutes, P=0.008) compared to Group B. Furthermore, Group A used less contrast material than Group B. Conclusion: Direct stenting offers a safer, quicker, and more cost-effective alternative to conventional stenting with balloon dilation in primary PCI. This method reduces radiation exposure, procedural costs, and operational time, potentially enhancing outcomes for patients and healthcare teams.

Antiproliferative agent attenuates postthrombotic vein wall remodeling in murine and human subjects

BackgroundDespite appropriate treatment, up to 50% of patients with proximal deep vein thrombosis will develop postthrombotic syndrome (PTS). Once PTS occurs, there is no specific treatment, and some patients constantly experience intolerable symptoms. Hence, prevention of PTS is important. ObjectivesTo characterize vein wall remodeling after thrombus and investigate the effects of antiproliferative agent on postthrombotic vein wall remodeling in murine and human subjects. MethodsFeatures of postthrombotic vein wall remodeling in murine and human subjects were characterized using imaging and histologic examinations. Paclitaxel-loaded hydrogels were used to assess the effects of antiproliferative agent on the remodeling in murine model. Based on the abovementioned results, a pilot study was conducted to assess the effects of paclitaxel-coated balloon dilation in patients with severe PTS experiencing intolerable symptoms. The control cohort was obtained by 1:1 propensity score matching from a prospective database. ResultsStructural and functional alterations in postthrombotic vein wall were verified by imaging and histologic examinations, and predominant active α-smooth muscle actin–positive cells and fibroblast-specific protein 1–positive cells proliferation was observed. In the murine model, the application of paclitaxel-loaded hydrogels inhibited the remodeling. In the pilot clinical study, patients receiving drug-coated balloon demonstrated benefits in Villalta scores and venous clinical severity scores compared with those not receiving drug-coated balloon, and no severe adverse events were reported except for thrombosis recurrence. ConclusionCell proliferation plays an important role in postthrombotic vein wall remodeling. Inhibition of cell proliferation inhibits the remodeling in murine model and may reduce signs and symptoms in patients with severe PTS.

Efficacy and Predictors of Success of Esophageal Hydraulic Balloon Dilation in Patients With and Without Previous Foregut Surgery

Background and AimsThe advantages of esophageal hydraulic balloon dilation include the ability to dilate up to 30 mm without fluoroscopic guidance and real-time display of the esophagogastric junction diameter during dilation. We aimed to explore the safety and efficacy of esophageal hydraulic balloon dilation in patients with and without previous foregut surgery, as well as to evaluate for predictors of clinical success. MethodsWe reviewed our database for patients who had esophageal hydraulic balloon dilation, and patients were divided into those with and without previous foregut surgery. Clinical success was determined by improvement in Eckardt/Brief Esophageal Dysphagia Questionnaire scores or, if not available, by physician assessment documented in the medical records. Technical success was defined as the ability to successfully perform esophageal hydraulic balloon dilation with visualization of the waist and stabilization of the balloon. Univariate analysis and logistic regression were used to evaluate predictors of clinical success after dilation. ResultsAmong 80 patients who had esophageal hydraulic balloon dilation (36 without and 44 with previous foregut surgery), clinical success was achieved in 48% of patients without previous foregut surgery (43% in achalasia and 73% in esophagogastric junction outflow obstruction) and 83% of patients with previous foregut surgery (87% in surgically treated achalasia and 80% in patients without achalasia with previous fundoplication). Technical success was achieved in 86% of patients without previous foregut surgery and 98% in patients with previous foregut surgery. There was 1 esophageal perforation (1.3%). Opiate use was a negative predictor of clinical success. ConclusionClinical success rates after esophageal hydraulic balloon dilation differ depending on the patient's foregut surgery history. Opiate users appear to have a lower clinical success rate compared with nonusers.

Simultaneous transcatheter aortic valve replacement and mitral balloon dilatation in patients with severe aortic stenosis and mitral stenosis: two case reports

Simultaneous transcatheter aortic valve replacement and mitral balloon dilatation in patients with severe aortic stenosis and mitral stenosis: two case reports

A novel balloon dilation catheter facilitating endoscopic papillary balloon dilation in patients with Roux-en-Y gastrectomy

Video 1Selective biliary cannulation was difficult, and the catheter tended to be cannulated into the pancreatic duct. We applied a double-wire technique to achieve biliary cannulation. Finally, selective biliary cannulation was achieved. Cholangiography revealed a small stone of approximately 5mm in the common bile duct (red arrow). Subsequently, endoscopic papillary balloon dilation (EPBD) was performed using a new EPBD catheter with a diameter of 8mm. This new EPBD catheter was inserted. We inflated this EPBD catheter slightly while observing both endoscopy and fluoroscopy monitors to confirm its dilation process. EPBD was easily and effectively performed without slipping in or out of the papilla. The orifice of the papilla was dilated. Stone extraction was completely achieved.

Addition of Mechanical Lithotripsy to Endoscopic Papillary Large Balloon Dilation in Patients with Difficult Common Bile Duct Stones: A Retrospective Single-Center Study.

Introduction: This study aimed to compare the treatment outcomes of endoscopic papillary large-balloon dilation (EPLBD) with and without mechanical lithotripsy (ML) in removing difficult common bile duct stones. Methods: Patients with difficult common bile duct stones treated with EPLBD, with or without ML, at the Eastern Chiba Medical Center between April 2014 and March 2020, were retrospectively evaluated. The rates of cumulative recurrence and complications were compared between the two groups. Results: Overall, 122 patients (n = 44, EPLBD + ML and n = 78, EPLBD) treated by 12 gastroenterologists were included. Patients in the EPLBD + ML group were older (85 years versus 81.5 years) and had larger maximum stone diameter (15 mm versus 12.5 mm) than those in the EPLBD group. Compared with the EPLBD group, the EPLBD + ML group required more endoscopic retrograde cholangiopancreatography (ERCP) procedures (≥2) (86% versus 67%) and longer total ERCP time after reaching the papilla (78.5 minutes versus 25 minutes). Complication rates were not significantly different (9.1% versus 12.8%); however, the cumulative recurrence rates were higher in the EPLBD + ML group than in the EPLBD group (69.4% versus 23.5% at 4 years). Conclusion: Although there were no differences in complication rates, the long-term recurrence rate was higher in the EPLBD + ML group than in the EPLBD group. This study emphasizes the added burden imposed by performing ML during ERCP and suggests that by appropriate case selection, it is possible to treat cases of difficult biliary stones using EPLBD without ML.

Balloon dilatation is superior to CO2 laser excision in the treatment of subglottic stenosis

IntroductionEndoscopic treatment of subglottic stenosis (SGS) is regarded as a safe procedure with rare complications and less morbidity than open surgery yet related with a high risk of recurrence. The abundance of techniques and adjuvant therapies complicates a comparison of the different surgical approaches. The primary aim of this study was to investigate disease recurrence after CO2 laser excisions and balloon dilatation in patients with SGS and to identify potential confounding factors.Materials and methodsIn a tertiary referral center, two cohorts of previously undiagnosed patients treated for SGS were retrospectively reviewed and followed for 3 years. The CO2 laser cohort (CLC) was recruited between 2006 and 2011, and the balloon dilatation cohort (BDC) between 2014 and 2019. Kaplan‒Meier and multivariable Cox regression analyzed time to repeated surgery and estimated hazard ratios (HRs) for different variables.ResultsNineteen patients were included in the CLC, and 31 in the BDC. The 1-year cumulative recurrence risk was 63.2% for the CLC compared with 12.9% for the BDC (HR 33.0, 95% CI 6.57–166, p < 0.001), and the 3-year recurrence risk was 73.7% for the CLC compared with 51.6% for the BDC (HR 8.02, 95% CI 2.39–26.9, p < 0.001). Recurrence was independently associated with overweight (HR 3.45, 95% CI 1.16–10.19, p = 0.025), obesity (HR 7.11, 95% CI 2.19–23.04, p = 0.001), and younger age at diagnosis (HR 8.18, 95% CI 1.43–46.82, p = 0.018).ConclusionCO2 laser treatment is associated with an elevated risk for recurrence of SGS compared with balloon dilatation. Other risk factors include overweight, obesity, and a younger age at diagnosis.

The Relationship Between Coronary Anatomy and Angina Pectoris During Stent Balloon Dilatation in Patients Undergoing Percutaneous Coronary Intervention.

Angina pectoris (AP) is defined as a clinical symptom characterized by sensations such as pressure-heaviness, burning, squeezing, or discomfort in different parts of the body, including the retrosternum, chest, jaw, neck, shoulders, and back. Limited publications exist on the impact of coronary artery disease localization on the placement, character, and severity of AP. This study aimed to investigate the relationship between the frequency of AP development due to myocardial ischemia during percutaneous coronary intervention (PCI), its character, severity, localization, and coronary anatomy. A total of 128 patients were included in the study, with 146 lesions treated among them. Among patients who underwent PCI of the right coronary artery (RCA), 31.1% reported no complaints. Similar rates were observed in patients undergoing PCI of the left anterior descending (LAD) and circumflex (Cx) arteries, at 23.7% and 19.1%, respectively. Pressure-heaviness was frequently observed in PCI of the LAD and Cx arteries, while burning was the dominant symptom description in PCI of the RCA. The isolated retrosternal and left thoracic regions were the most common localizations in all main coronary arteries. Epigastric localization occurred most frequently in PCI of the RCA. In terms of the severity of angina, no significant difference was observed between the three coronary arteries. Pressure-heaviness angina was commonly observed during PCI of the LAD and Cx, while burning angina was frequent during PCI of the RCA. The severity of AP was similar across the three main coronary arteries.

Endoscopic Intrapyloric Botulinum Toxin Injection with Pyloric Balloon Dilation for Symptoms of Delayed Gastric Emptying after Distal Esophagectomy for Esophageal Cancer: A 10-Year Experience.

Patients with esophageal cancer undergoing esophagectomy have an improved survival over time, however adverse events associated with the use of a gastric conduit are increasingly being reported. Delayed gastric emptying (DGE) is an esophagectomy-related complication which can decreased quality of life by causing debilitating gastrointestinal symptoms and malnutrition. The aim of our study was to evaluate the effect of endoscopic intrapyloric botulinum (BT) injection in combination with pyloric balloon dilation in patients with DGE following distal esophagectomy at our tertiary cancer center. Patients with a prior history of distal esophagectomy who had also undergone endoscopic BT injection with pyloric balloon dilation by a single endoscopist between 2007 and 2017 were included in the study. One hundred units of BT were injected endoscopically into the pylorus in four quadrants using an injection needle. Following BT injection, a standard through-the-scope balloon was passed to the pylorus and inflated to a maximum diameter of 12−20 mm. For patients who underwent repeat procedures, the symptomatic outcomes were assessed and documented by the endoscopist; for the other patients, the electronic medical records were reviewed. A total of 21 patients undergoing 44 endoscopic intrapyloric botox injections combined with balloon dilatations were identified. The patients underwent the procedures at a median of 22 months (range, 1−108 months) after esophagectomy. The procedures were performed only once in 43% of the patients; 43% patients underwent the procedure twice, while 14% had it multiple times (>2). Overall, intrapyloric BT injection coupled with balloon dilation was a safe procedure, without any major immediate or delayed (1 month) procedure-related adverse events. Eighteen patients (85%) reported a significant overall improvement in symptoms from the initial presentation. One patient (5%) showed no improvement, whereas in two (10%) patients responses were not available. In our particular cohort of patients, the interventions of endoscopic intrapyloric BT injection with pyloric balloon dilation proved to be very beneficial, leading to significant symptomatic improvement. The balloon dilation after BT injection might have resulted in better diffusion of the BT into the pyloric sphincter complex, possibly increasing its therapeutic effects. Further prospective studies are needed to validate these results.

Efficacy and safety of endoscopic pyloric balloon dilation in patients with refractory gastroparesis.

There has been interest in the use of pyloric therapies for the treatment of refractory gastroparesis. However, data on endoscopic pyloric dilation are scarce. We aimed to assess the efficacy and safety of this procedure in refractory gastroparesis. We performed a retrospective analysis of 47 patients referred for refractory gastroparesis, confirmed by gastric emptying scintigraphy, and treated with endoscopic pyloric through-the-scope balloon dilation. The primary endpoint was the effectiveness of the procedure, evaluated with the Gastric Cardinal Symptom Index (GCSI) at 2 and 6months. A clinical response, defined by a 1.0 point decrease in the GCSI score, was observed in 25 patients at 2months (53%) and in 19 patients at 6months (40%). The mean GCSI score decreased significantly at 2 and 6months compared to the preoperative score (3.9 ± 0.87 vs 2.3 ± 1.37 and 3.9 ± 0.87 vs 2.9 ± 1.27, respectively; p < 0.0001). No complication was observed. Nine patients had a delayed relapse at 1year. A second dilation was performed for eight patients and it was effective in five of them (63%). The mean follow-up time of the patients was 27.0 ± 10.4months. At 2years, 15 patients still experienced improvement following this treatment (32%). No predictive factor of clinical response was identified. The efficacy of pyloric dilation is 53% at 2months, with sustained improvement in one third of patients at 2years. This treatment should be considered as an alternative option to pyloromyotomy.

Stenting versus balloon dilatation in patients with tracheal benign stenosis: The STROBE trial.

BackgroundIt is well known that benign tracheal stenosis represents an obstacle to open surgery, and that its treatment could be challenging. Two endoscopic techniques have so far been adopted to restore tracheal patency: balloon dilatation (BA) through laryngoscopy, and tracheal stenting (ST) with rigid bronchoscopy. The main objective of this study was to compare the efficacy of BA and ST to treat benign tracheal stenosis not eligible for surgery. We also compared the rate of adverse events in the two treatment groups.MethodsA retrospective, observational cohort study was carried out at the University Hospital of Modena (Italy) from November 2012 to November 2017 in two separate departments. Patients were considered to be “stabilized” (primary outcome) if they did not report significant respiratory symptoms, or restenosis in the long‐term (2 years) following the endoscopic procedure.ResultsSixty‐six patients were included in the study (33 in the BA and 33 in the ST group, respectively). Unadjusted Kaplan–Meier estimates showed a greater therapeutic effect of ST compared to BA at 2 years (hazard ratio = 3.9 95%CI [1.5–9.8], p = .01). After adjusting for confounders, stratified analyses showed that this effect was significant in patients with complex stenosis, idiopathic etiology, and degree of stenosis >70%. Compared with BA, ST showed a higher rate of adverse events (p = .01).ConclusionsCompared to BA, ST seems to be more effective in achieving stabilization of tracheal patency in complex benign tracheal stenosis, although burdened with a significantly higher number of adverse effects. These findings warrant future prospective study for confirmation. Level of evidence: 3.

Can computed tomography-antral wall thickness predict response to endoscopic balloon dilation in patients with caustic-induced gastric outlet obstruction?

Caustic-induced gastric outlet obstruction (GOO) remains one of the important causes oflong-term morbidityin patients with caustic ingestion. Though endoscopic balloon dilation is an effective modality, response to caustic GOO is poorer as compared to peptic stricture. Computed tomography (CT)-antral wall thickness (AWT) has not been previously explored to predict the procedural success in patients with caustic GOO. In a retrospective single-center study of prospectively maintained database, all patients with symptomatic caustic GOO who underwent CT scan prior to endoscopic balloon dilation were included. Gastric AWT was measured at the site of maximum visible thickness on CT scan. Details regarding caustic ingestion and endoscopic dilation were retrieved. Patients were divided into two groups, based on CT-AWT (< or ≥9 mm) and compared for outcome measures. Mean age of included patients (n=35) was 33.51 ± 13.65 years and 22 were male. Procedural success was achieved in 29 (82.85%) patients. Number of mean dilation sessions required were5.28 ± 2.96 for achieving procedural success. The mean CT-AWT was 10.73 ± 2.80 mm (range 4-18 mm). There was no significant association between the CT-AWT and the number ofdilations and procedural success. On univariate analysis, size of the first balloon used was a predictor of refractory stricture (p=0.011). However, no other factors predicted either refractory stricture or procedural success. There is no additional role of CT-AWT in predicting response to endoscopic balloon dilation or to predict refractory stricture in patients with caustic GOO.

Assessment of the Balloon Dilation Efficiency in Bladder Neck Contracture after Transurethral Interventions on the Prostate

Purpose: The aim was to assess the results of balloon dilation in patients with bladder neck contracture (BNC) after endoscopic surgery for benign prostatic hyperplasia (BPH). Materials and Methods: The study involved 120 patients with recurrent BNC after transurethral interventions for BPH. All patients underwent transurethral resection (TUR) of the bladder neck and were divided into two groups: Group A (n = 45) included men who, after TUR, additionally underwent repeated balloon dilation, whereas the control group B (n = 75) included men who were treated with alpha-blockers alone. Results: In 9 months after TUR and 3 months after the 4th balloon dilation procedure in Group A, the mean international prostate symptom score (IPSS) decreased from 20.1 ± 8.4 to 17.2 ± 7.4, and the IPSS-quality of life was 4.2 ± 1.2 (P &gt; 0.05). In Group B, they were 21.7 ± 7.7 and 4.7 ± 1.1 (P &gt; 0.05), respectively. In addition, the mean flow rate in Group A was 13.2 ± 5.4 ml/s, whereas in Group B, it was 8.7 ± 4.9 ml/s (P &lt; 0.05). There was a significant decrease in the postvoid residual urine volume from 76.2 ± 96.1 ml to 37.6 ± 55.1 ml in Group A, whereas, in Group B, it increased from 63.0 ± 36.9 ml to 79.4 ± 71.6 ml (P &gt; 0.05). Furthermore, 28.0% of patients of Group B and 13.3% of patients of Group A underwent repeated TUR of the bladder neck in 9 months follow-up period (P &lt; 0.05). Conclusion: Balloon dilation is a safe less invasive procedure and can reduce the possibility of BNC recurrence and thus the rate of repeated transurethral interventions.

Long-term effects of endoscopic papillary large balloon dilation in patients with challenging bile duct calculi: A retrospective observational study.

Endoscopic papillary large balloon dilation (EPLBD) can be used to treat challenging common bile duct stones. No previous studies have reported intractable cases treated either by EPLBD or mechanical lithotripter use. We aimed to evaluate and compare the long-term effects of EPLBD with mechanical lithotripter use.This retrospective cohort study reviewed data from 153 patients admitted to the Eastern Chiba Medical Center from April 2014 to March 2020, presenting with common bile duct calculi that could not be removed using a basket or balloon catheter. Patients were divided into groups depending on whether the treatment was performed using a mechanical lithotripter or EPLBD. The primary outcome was the recurrence rate of common bile duct calculi, and the secondary outcome was the rate of postoperative adverse events. The Wilcoxon test was used to compare the 2 groups. Statistical significance was set at P < .05.The median age of patients included in the lithotripter and EPLBD groups were 73 years and 83 years, respectively (P = .006), while the sex ratio (male:female) in the groups was 18:13 and 55:67, respectively. The EPLBD group showed a statistically larger median bile duct diameter (13 mm [range: 8–24 mm] vs 11 mm [range: 5–16 mm]; P < .001), larger maximal calculus diameter (median, 13.5 mm [range: 8–25 mm] vs 11 mm [range: 7–16 mm]; P < .001), and shorter median cumulative treatment time after reaching the duodenal papilla (35.5 minutes [range: 10–176 minutes] vs 47 minutes [range: 22–321 minutes]; P = .026) in comparison to the lithotripter group. There was no significant difference in the rate of adverse events between the EPLBD and the mechanical lithotripter groups. The recurrence rate was significantly lower (P = .014) in the EPLBD group.EPLBD increases therapeutic efficacy and reduces treatment duration for patients in whom calculus removal is difficult, without increasing the frequency of adverse events. No serious adverse events were observed. Additionally, EPLBD appears to reduce the risk of long-term recurrence. Future studies are needed to evaluate long-term outcomes in younger patients.

Resolution of symptoms after Heller's cardiomyotomy with DOR fundoplication versus endoscopic balloon dilatation in patients with achalasia Cardia at tertiary care hospital.

To compare improvement in symptoms following Heller's myotomy with Dor fundoplication and endoscopic pneumatic dilatation for the treatment of achalasia cardia. The prospective comparative study was conducted at the Department of Upper Gastroenterology and Minimally Invasive Surgery, Civil Hospital, Karachi, from February 2016 to January 2019, and comprised patients diagnosed with achalasia cardia on oesophageal manometry. The subjects were randomised into endoscopic pneumatic dilatation group A and laparoscopic Heller's myotomy with Dor fundoplication group B. Eckardt scores were compared between the groups at one-year follow-up. Data was analysed using SPSS 22. Of the 42 patients, 21(50%) were in each of the two groups. The mean age of patients in group A was 37±12.87 years compared to 34±8.59 years in group B. Treatment success in group A was 11(52%) compared to 21(76%) in group B. Eckardt scores between the groups were significant (p<0.001). Patient satisfaction was significantly more in group B (p<0.05). The efficacy of Heller's myotomy with Dor fundoplication was found to be greater than endoscopic pneumatic dilatation for improvement in dysphagia and overall patient satisfaction at one-year follow-up.

Balloon dilatation of cicatricial bladder neck contracture: evaluation of the efficacy after transurethral prostate interventions (preliminary results)

Introduction. Cicatricial bladder neck contracture (CBNC) is one of the most common complications after endoscopic prostate procedures. There is no consensus among urologists about which method is advisable to use in the treatment of postoperative CBNC — transurethral resection (TUR) or incision. In this regard, the study of balloon dilation is a promising alternative. Purpose of the study . To improve the results of balloon dilation in patients with CBNC after endoscopic surgery for BPH. Materials and methods. The study involved 34 patients with recurrent CBNC after TUR and laser enucleation. The patients were divided into 2 groups: group A (n = 16) included men who, after bladder neck's TUR, additionally underwent transurethral balloon dilatation, while control group B (n = 18) included men who were prescribed conservative therapy only using alpha-blockers. Results. 2 months after the bladder neck's TURP and 1 month after balloon dilatation in group A, the mean IPSS score was 14.2 ± 2.1, QoL was 2.9 ± 0.9, while in group B it was at the end of 2nd month after the bladder neck's TURP, these indicators were 16.2 ± 3.1 and 3.9 ± 0.8 points, respectively (p <0.05). The average maximum urine flow rate in group A was 15.8 ± 2.8 ml/sec, in group B was 11.6 ± 2.8 ml/sec (p <0.05). Also, a significant decrease in the residual urine volume was revealed from 43.4 ± 34.4 to 27.8 ± 12.5 ml in group A, while in group B this indicator decreased from 49.1 ± 30.2 to 30.2 ± 11.7 ml. Conclusions. The method of transurethral balloon dilatation in case of CBNC under TRUS control using local anaesthesia only avoids gross trauma to the urethra and bladder neck with a cystoscope or mechanical dilatator. It helps to reduce the likelihood and severity of complications of this treatment method.

Effect of inhaled fluticasone propionate on laryngotracheal stenosis after balloon dilation: a randomized controlled trial.

PurposeLaryngotracheal stenosis describes various airflow compromising conditions leading to laryngeal and tracheal narrowing, including subglottic and tracheal stenosis. Direct laryngobronchoscopy is the diagnostic gold standard for laryngotracheal stenosis. This study aimed to explore the effect of inhaled fluticasone propionate as adjuvant medical therapy in patients with laryngotracheal stenosis after balloon dilation. MethodsThis prospective randomized controlled trial was conducted from April 2019 to April 2020. Fourteen adults (≥ 18 years) with laryngotracheal stenosis consented to participate. All patients underwent endoscopic balloon dilation. Seven patients were treated with inhaled fluticasone propionate, and seven acted as controls. Detailed documentation of operative findings and pre- and post-balloon dilation spirometry measurements were recorded. Basic demographic data and operative details, including information about the percentage of laryngotracheal stenosis, distance of laryngotracheal stenosis from the vocal cords, the stenotic segment vertical length, and the largest endotracheal tube used before and after dilation were noted. ResultsSpirometry measurements were obtained on 34 occasions (17 before and 17 after balloon dilation). The two groups were similar in spirometry values after treatment. Both groups had significantly improved on most spirometry values after balloon dilation.ConclusionWe found that using inhaled steroids after balloon dilatation in patients with laryngotracheal stenosis had no benefit over non-user patients in spirometry parameters during the short postoperative follow-up. To confirm this outcome, we recommend a large-scale double-blind study with a longer follow-up period. Supplementary InformationThe online version contains supplementary material available at 10.1007/s00405-021-06622-x.

Local thrombolysis combined with balloon dilation for patients with severe cerebral venous sinus thrombosis.

Local thrombolysis combined with balloon dilation for patients with severe cerebral venous sinus thrombosis.

Predictors of necessity for endoscopic balloon dilatation in patients with Crohn’s disease-related small bowel stenosis

Background and Aim In patients with Crohn’s disease (CD) and small bowel stenosis, endoscopic balloon dilation (EBD) is considered to be useful in improving stenotic symptoms and avoiding surgery. However, it carries risks such as bleeding and perforation. The aim of this study was to identify the indications for endoscopic intervention in patients with CD and small bowel stenosis. Methods From November 2007 to March 2020, 143 CD patients with small bowel stenosis were enrolled in this study. We identified the factors associated with not requiring endoscopic intervention during long-term follow-up of these patients. Results Forty of the 143 patients had abdominal symptoms of stenosis and had undergone EBD, whereas the remaining 103 were asymptomatic and had not undergone endoscopic intervention. During long-term follow-up, 95 of those 103 patients never required endoscopic or surgical intervention. Multivariate logistic regression analysis revealed that not consuming an elemental diet (OR 3.18, 95% CI 1.48–6.82; p < .01) and ileocecal valve (ICV) stenosis (OR 0.30, 95% CI 0.11–0.83; p = .02) were independently associated with not requiring EBD. The cumulative emergency hospitalisation-free rate also tended to be higher in patients not consuming an elemental diet or with ICV stenosis. Conclusions Two factors, namely not consuming an elemental diet and ICV stenosis, predict a long-term intervention-free prognosis in CD patients with small bowel stenosis. Key messages When an endoscopically impassable small bowel stenosis is found in a CD patient, long-term follow-up without endoscopic intervention may be possible if the patient is asymptomatic, is not using an elemental diet, and the stenosis is ICV.

388 Endoscopic Intrapyloric Botulinum Toxin Injection With Pyloric Balloon Dilation for Delayed Gastric Emptying After Distal Esophagectomy for Esophageal Cancer: A 10-Year Experience

INTRODUCTION: As patients with esophageal cancer undergoing esophagectomy have an improved survival over time, complications associated with the use of a gastric conduit are increasingly being reported. Delayed gastric emptying (DGE) is an esophagectomy-related adverse event which may cause debilitating symptoms, malnutrition and decreased quality of life. The aim of our study was to evaluate the effect of endoscopic intrapyloric BT injection combined associated with pyloric balloon dilation in patients with DGE after distal esophagectomy treated at a tertiary cancer center. METHODS: Patients with a prior history of esophageal cancer and distal esophagectomy who had undergone endoscopic BT injection with pyloric balloon dilation by a single endoscopist between 2007 and 2017 were included in the study.100 units of BT were injected endoscopically into the pylorus in four quadrants using a standard needle. Following BT injection, a standard through-the-scope balloon was passed to the pylorus and inflated to a maximum diameter of 12-20 mm. For patients who underwent repeat procedures, the symptomatic outcomes were assessed and documented by the endoscopist; for the other patients, the electronic medical records were reviewed. RESULTS: A total of 21 patients undergoing 44 endoscopic intrapyloric botox injections combined with balloon dilatations were identified. Baseline characteristics are summarized in Table 1. The patients underwent the procedures at a median of 22 months (range, 1-108 months) after esophagectomy. The procedures were performed only once in 43% of the patients; 43% patients underwent the procedure twice, while 14% had it multiple times.Overall, intrapyloric BT injection coupled with balloon dilation was a safe procedure, without any major immediate or delayed (1 month) procedure-related adverse events. 18 patients (85%) reported a significant overall improvement in symptoms from the initial presentation. One patient (5%) had shown no improvement, whereas in two (10%) patients responses were not available. CONCLUSION: In our particular cohort of patients, the interventions of endoscopic intrapyloric BT injection with pyloric balloon dilation proved to be very beneficial, leading to significant symptomatic improvement. The balloon dilation after BT injection might have resulted in better diffusion of the BT into the pyloric sphincter complex and possibly increasing its therapeutic effects. Further prospective studies are needed to validate these results.